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Individual
MRS. BRIDGET R LOGAN
Active
Individual
MRS. BRIDGET R LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112901
ORTHONET PROVIDER I.D.#
CT
01
—
080005891CT01
ANTHEM PROVIDER I.D.#
CT
Enumeration date
08/30/2006
Last updated
09/15/2020
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